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目的对接受调强放疗的子宫内膜癌淋巴结复发患者的生存率进行分析,并探讨影响生存率的影响因素。方法以2012年9月—2013年10月浙江省人民医院放疗科收治的40例子宫内膜癌淋巴结复发患者为研究对象,全部患者采用调强放疗,以放疗前以及同步放疗时接受化疗方案的不同为分组依据,分析不同化疗方案下FIGO分期、复发部位数量、复发部位、病理分类、分化程度特征差异,Kaplan-Meier法计算全部患者生存率,比较不同化疗方案下患者的生存率差异。结果接受放疗前初始化疗患者14例(35%),放疗时同步化疗22例(55%)。FIGO分期Ⅰ/Ⅱ期21例、Ⅲ/Ⅳ期19例,单处复发15例、多处复发25例,复发部位大小<3 cm 23例、≥3 cm 17例,盆腔复发13例、腹主动脉旁淋巴结复发8例、盆腔+腹主动脉旁淋巴结复发19例,子宫内膜腺癌31例、透明细胞癌3例、腺麟癌3例、浆液性腺癌3例;低分化7例、中分化22例、高分化11例;不同放疗方案下的患者FIGO分期、复发部位、复发部位数量和大小、病理分类、分化程度特征差异无统计学意义(P>0.05)。患者2年总体生存率为72.5%,放疗前化疗患者生存时间较未接受初始化疗的患者短(P=0.043),放疗时同步化疗患者的生存时间更长(P=0.045),差异有统计学意义(P<0.05)。结论调强放疗同步化疗可提高子宫内膜癌淋巴结复发患者远期生存时间,而放疗前化疗不利于生存率的改善。
Objective To analyze the survival rate of patients with lymph node recurrence of endometrial carcinoma receiving intensity modulated radiotherapy and to explore the influencing factors of survival rate. Methods From September 2012 to October 2013, 40 cases of endometrial cancer recurrence in patients with endometrial cancer treated by Department of Radiation Oncology, Zhejiang Provincial People’s Hospital were enrolled in this study. All patients received IMRT before chemotherapy and concurrent radiotherapy Different groups were grouped according to different chemotherapy regimen, FIGO staging, number of recurrence sites, recurrence sites, pathological classification, differentiation degree characteristics, Kaplan-Meier method to calculate the survival rate of all patients, and compare the survival rate of patients under different chemotherapy regimens. Results The patients received initial chemotherapy before radiotherapy in 14 patients (35%), radiotherapy, concurrent chemotherapy in 22 patients (55%). FIGO stage Ⅰ / Ⅱ 21 cases, Ⅲ / Ⅳ 19 cases, 15 cases of single recurrence, multiple recurrent in 25 cases, the size of the recurrence site less than 3 cm 23 cases, ≥ 3 cm in 17 cases, pelvic recurrence in 13 cases, There were 8 cases of recurrence of para-aortic lymph node, 19 cases of pelvic and para-aortic lymph node recurrence, 31 cases of endometrial adenocarcinoma, 3 cases of clear cell carcinoma, 3 cases of adenocarcinoma, 3 cases of serous adenocarcinoma, 7 cases of poorly differentiated 22 cases were differentiated and 11 cases were highly differentiated. There was no significant difference in FIGO staging, number of recurrence sites, number and size of recurrence sites, pathological classification and differentiation among patients under different radiotherapy regimens (P> 0.05). The 2-year overall survival rate of patients was 72.5%. The survival time of patients before radiotherapy was shorter than that of patients without initial chemotherapy (P = 0.043). The survival time of patients receiving radiotherapy was longer (P = 0.045), the difference was statistically significant Significance (P <0.05). Conclusion IMRT chemotherapy can improve long-term survival time of patients with lymph node recurrence of endometrial cancer, and chemotherapy before radiotherapy is not conducive to the improvement of survival rate.